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24A-039 (2) 48 BLACKBERRY LN BP-2020-1119 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A-039 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Abovegroundpool BUILDING PERMIT Permit# BP-2020-1119 Project# JS-2020-001875 Est.Cost: $6973.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor:. License: Use Group: TEDDY BEAR POOLS & SPA 111889 Lot Size(sq.ft.): 10410.84 Owner: CALDWELL-O'KEEFE RILEY Zoning.URB000)/ Applicant. TEDDY BEAR POOLS & SPA AT. 48 BLACKBERRY LN Applicant Address: Phone: Insurance: 41 EAST ST (413) 594-2666 O Workers Compensation CHICOPEEMA01020 ISSUED ON.5/12/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:18X52 ABOVE GROUND POOL POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 5/12/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 4('z li The Commonwealth of Massachusetts D° ' ; Board of Building Regulations and Standards 2 FOR D al ?�� M ICIPALITY >� j Massachusetts State Building Code,780 CMI�'',� q L}SE o } ' i Building Permit Application To Construct, Repair, Renovate Dol��z;_a. evised Mar 2011 OrE�'l 7_ One-or Two-Family Dwelling s i o m I This Section For Official Use Only i 0 c:.a ° Building Permit Number: ate Applied: N �— Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.2 Assessors Map& Parcel Numbers 48 Blackberry Lane o3q l.la Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' lleV & Jess a well - Okeefe Northampton, MA 01060 Name(Print) City,State,ZIP 48 Blackberry Lane 805-223-0340 ieneratorc(c)yahoo.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units _�- Pool 'wound Pemoi (18' x 52") Ar�oy� <020Q'-AD Poo" (18 " x SZ " SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ co 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical ❑ Standard City/Town Application Fee $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mcchanical (HVAC) $ List: 5.Mechanical (Fire $ Su ression Total All Fees:$ 1 Check No. Check Amount: 4 Cash Amount: $ �� 0 Paid in Fu uflv 0 Outstanding Balance Due: Here is your Permit information Apply for your building permit with your city/town. The permit application must be posted. Please • Call Dig Safe - (Massachusetts: 888-344-7233 nn,ec .icut; 80Q_- . Typically, there is a 3 day waiting process once contacted before you can dig. • Get in touch with your electrician - give an idea of general time frame to them. The electrical work should be done soon after the pool is installed (within a couple of days). • Contact your insurance company. It is a good idea to ask about adding your pool to your insurance coverage in the event of a bad winter with heavy snow load. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZiP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Tele one Email address D Demolition Teddv Bear Pools & Spas 111889 02/08/2021 HIC Compare Name or HIC Registrant Name HIC Registration Number Expiration Date 41 East Street scotta aAteddybearpools.com No.and Street Email address Chicopee, MA 01020 413-594-2666 Ci /Town State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes..........❑� No...........0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize Teddv Bear Pools & Spas _ to act on my behalf,in all matters relative to work authorized by this building permit application. T2tt,F-N „v�mac.-O� r - 10 — Z lectronic Signature) SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application.is true and accurate to the best of my knowledge and understanding. Scott Alexander 4/27/2020 lectronic Signature) NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.e. 142A.Other important information on the HIC Program can be found at www.mass.goy/oca v�Information on the Construction Supervisor License can be found at www.mass. og v/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of.IndustrialAccidents 1 Congress Street,Suite 100 Boston,111A 02114-2017 www.mass.gov/dia 'Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERWMNG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/ludividual):Teddy Bear Pools & Spas Address:41 East Street City/State/lip:Chicopee, MA 01020 Phone#:413-594-2666 Are you an employer?Check the appropriate box: Type of project(required): 1.✓0 I am a employer with 1 00 employees(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 9. ❑Remodeling 3.O I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.r]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 []Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.a 1 am a general cofactor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.t 1Roof repairs 6.❑We area corporation and its officers have exercised their right of exemption per MGL c. 144.. ✓�Other POOI 152,§1(4).and we have no employers.[No workers'comp.insurance required.] *Arry applicaut that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContraetois that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance company Name:HUB International New England Policy#or Self-ins.Lic.#:CPL 8665062 _ Expiration Date:04/01/2021 Job Site Address: 48 Blackberry Lane City/State/zip:_Northamp ton, MA 01060 _ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punisbable by a rite up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature:Scott Alexander Date: 4/27/2020 Phone#: 413-594-2666 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TEDDBEA-01 MPRO CERTIFICATE OF LIABILITY INSURANCE DATEYYYY) a112/2o22/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER Ic TACT HUB International New England LLC PHONE,Exq:1800)243-8134 Ne:413 731-9539 1070 Suffield Street - ----.— Agawam,MA 01001 ADOR E•MAILSS` -- —�- _ INSURERIS)AFFORDINGCOVERAGE _ NAIC! INSURER •Central Insurance COm n _ 20230 INSURED INSURER B:Arbeila Protection Insurance Company ;17000 Teddy Bear Pools Inc. INSURERc;____ 41 East St INSURER 0; Chicopee,MA 01020 SURERE: rI INSURER F: COVERAGES CERTIFICATENUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY ITE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EFf POLICY EXP LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER LIMITS A X COMMERCIAL GENERAL W181UTY 1.000.000 EACH OCCUR_REC_E_ _N _ CLAIMS-MADE OCCUR CLP 8665062 41112020 4/1/2021 DAMAGE TO RENTED 300.000 D EXP omperscnl S 10,000 PERSONAL R ADV MJ RY 1 1'000'000 GEWL I"SPER GENERAL A R — 2'0 '000 IL JI POLICY COT LOC PRODUCTS__COLPMEAG 2,000,000 OTHER-- B THERB AUTOMOBILE U1181LITY I COMBINED SINGLE LIMIT 1,000,000 accideno ANYAUTO + 1020085353 7/1/2019 711/2020 ' BODILYINJ OVMEO SCHEDULED BODILY INJURY Per saf)_ AUTOS HHRREE�� ONLY X AUUTNOpSyyryEp BODILY INJURY Per socidem X AlTT6S ONLY X AUTOS ONLY P AMAGE - $ — UMBRBLLAUAB OCCUR EACH OCCURRENCE III EXCESS LIAB CLAIMS-MADE AGGREGATE DEC) I I RETENTION E A WORKERS COMPENSATION X PER &H- AND EMPLOYERS'LIABILITYA LITE ApNFY PROPREIETgOERIPARTNERIEXECUTIVE YIN WC 8665063 4/112020 41112021 EACH IDM 500,000 (MaF datory in NHR EXCLUDE09 u N!A �,0� Hyes dela n tr der EL DISEASE-EA EMPLOYE E III DESCRIPTK)N OF OPERATIONS below DISE E-POLICY LIMIT 500'000 i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES IACORD 101,Additional Remarks Schedule,maybe attached*more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Verification of Insurance Purposes Only qTHECCORDANEXPIRATION WITH THE POLICY P TE THEREF, ONS.E WILL BE DELIVERED IN AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Teddy Bear Pools, Inc. , ►��Tr 41 East Street • Chicopee, MA 01020 (413) 594-2666 -b (800) 554-BEAR FAX (413) 598-8823 4K Home Improvement_ ConMi.MA��k11.88WBE .�9.�UM520951 W,L4v Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation TEDDY BEAR POOLS&SPAS INC Registration: 111889 41 EAST ST Expiration: 02/07/2021 CHICOPEE,Mn 01020 Update Address and Return Card. SCA 1 0 20M-05/17 -ate STATE OF tL'®Nle1ECTgCIJT' �? I)EPARTMENT QBE CONSUMER PROTECTION Be it known that. TEDDY BEAR POOLS INC 41 EAST ST CHICOPEE, MA 01020-2605 has,satisfied the qualifications requ rcd by law and is hereby registered as a HOME IMPROVEMENTCONTRACTOR a Registration # HIC.0520951 Effective: 12/01/2019 Expiration: 11/30/2020 - ' s Michelle Seagull,Commimioner TEDDY BEAR POOLS 9 SPAS NEI OEM No "MEN 0 Nowmmomm"IMMEMIS SOON mumm Mir rail. .0 No 10"Nom 11 NO son SEEM ME so Mill ■ MMMMMMMMMMM MENJISM MEN sommommumom an 0 in 0 0 Al � in �% � ■�i All wilumommmomm MUMS As FR I imililin I I HE lillilin OWNS= a mosimoms m----Noun 0 ME am "mllonl- Ill I MEMMMIN MUMMEMEMS was maul tNo � ■ -) Above Ground Pool 4V Plot Plan I-sr . The plot plan below is approximate measuremen r the \pool placement at the home of: Customer Info: -JO Lk c' -J U�k VA I J ec ie In the City/Town of: Above groun of set backs arc: �' of Nouse ' Side _Rear Septic leach Field �O. i Draw out you backyard including the back of your home and t lines.Show measurements from lot lines,both sides and rear as well as from the back of th ouse. (See example on back of page). This plan was completed by: Date: 41 East Street • Chicopee, MA 01020 • (413) 594-2666 • (800) 554-BEAR • www.teddybearpooK.Com